In her book “No Time to Say Goodbye” Carla Fine talks about her husband’s suicide. Harry was a doctor with a successful private practice. He was a pioneering researcher in the field of urology and had fourteen published articles in a medical journal.
There were two disturbing facts about Harry’s death. There was evidence that he had researched what drug would be the most effective in ending his life. He chose Thiopental, a drug used to execute prisoners in some states of America where capital punishment is legal. And secondly, he was seeing patients two hours before he injected himself intravenously.
There is something incongruous about a member of the medical profession taking their life. They are so often cast in the role of helper, supporter, and life preserver. And yet they face the same challenges we all face. Harry lost both his parents within eighteen months of each other. Three months after his father’s death he ended his life by lethal injection. Under pressure from his wife, he had reluctantly sought professional help but was resistant to any treatment plans. Harry had his own plan and he had put his signature to it.
The media recently reported the death of a Brisbane doctor and father-of-four, Dr Andrew Bryant. He also died in his office after more than 20 years working as a gastroenterologist at his private practice and public hospitals in Brisbane. His wife Susan has been open about the way her husband died. An email she wrote was posted online by her son John and has since been viewed and shared thousands of times.
“If more people talked about what leads to suicide, if people didn’t talk about as if it was shameful, if people understood how easily and how quickly depression can take over, then there might be fewer deaths.”
Ms Bryant accepts that in retrospect, the signs were all there.
“Andrew had never before suffered from depression. He hadn’t been sleeping well since late February, but he was never a great sleeper. He was very busy with work but had always been busy. Just before Easter, he became anxious – about his private practice, about being behind in his office administration, about his practice finances, about some of his patients, about his competence. He seemed dispirited and non-communicative.”
Medical professionals are supposed to have the answers. Their work is about consultation, diagnosis and treatment. Ms Bryant said her husband didn’t know what was going on with his own health despite being a doctor.
A recent study published in the Medical Journal of Australia (2016) looked at suicide by health professionals. It stated that broadly speaking, health professionals are healthier and live longer than the general population. However, research has identified elevated rates of suicidal ideation and death by suicide among certain groups of health professionals, including doctors, nurses and dentists.
In explaining why this is so, lead author Dr Allison Milner of Deakin University said,
“Medical professionals are exposed to higher rates of stress than other professions, due to long working hours, work-family conflicts, and fears of making mistakes.
These stresses are associated with the development of mental disorders such as anxiety and depression, often worsened by exposure to trauma through contact with patients and their families.
Yet female health professionals also experience additional sources of gender role stress, such as pressures to undertake childcare and household roles.”
In view of the above, it is not surprising to learn female doctors take their own lives at nearly three times the rate of the general population.
Chloe Abbott had just landed a job at Sydney’s St Vincent’s Hospital to do her physician training, with dreams of becoming an endocrinologist.
Last year those closest to her began to notice the determined young doctor was struggling. A friend of Chloe’s recalled she was also grappling with the death of a colleague, a young registrar who had taken her own life.
Later in the year, Chloe was admitted to a psychiatric inpatient ward. Few knew at the time that she was facing a career crisis: her medical registration had been suspended.
In January this year, Chloe took her own life.
Researchers advocate the development of new suicide prevention strategies in hospitals and clinics. The following stresses are commonly faced by medical professionals –
- sleep deprivation
- immersion in human suffering
- long work hours
- work/family pressures
- high expectations
- a dread of making mistakes
- uncomfortable acknowledging vulnerability
- adapting to radically changing health care environment.
A new suicide prevention strategy needs to make provision for the following –
- doctor training programs to address a ‘culture of abuse’ too often characterised by bullying, harassment and humiliation
- confidential counselling and psychotherapeutic assistance for those who are stressed and burned out
- sessions to teach medical professionals how to have a greater self-awareness of emotional needs and how to manage stress
- team building exercises that destigmatise help seeking
- regular screening and assessment to determine mental wellness
- educational programs to increase physicians’ awareness of warning signs of suicidal ideation such as observable signs of serious depression
- procedures that limit access to prescription medicines.
Over thirty years ago D. W. Preven said,